Aspergillosis: From the Breeze or from the Bucket?

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Abstract
Invasive aspergillosis is the greatest infectious threat to the survival of bone marrow transplant recipients and certain solid-organ transplantation patients. Mortality, which can exceed 80%, is so high for documented disease that attention has focused increasingly on prevention. Prevention includes both antifungal prophylaxis and the separation of patients from sources of infection. We have traditionally used early prophylaxis while the patient is hospitalized, but recent studies have shown that development of invasive aspergillosis after bone marrow transplantation may be delayed until a time long after patients have returned home [1]. Also, the sources of Aspergillus infection may be broader than we think. In this issue of Clinical Infectious Diseases, Anaissie and Costa [2] present evidence that implicates the water supply as a major source of mycelial fungal infection. Hajjeh and Warnock [3] support the more traditional view that there is greater risk of airborne transmission of infection. When to use antifungal prophylaxis and how to shelter patients from Aspergillus infection may be more complicated than we once thought.

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